Hernia Specialists Vienna – Hernia Surgery & Abdominal Wall Hernias

A hernia – also called an abdominal wall hernia or rupture – occurs when abdominal contents (e.g., bowel or fatty tissue) protrude through a weak spot in the abdominal wall musculature. This often results in a visible bulge or swelling that may become larger with pressure or exertion. Hernias may be congenital or develop over time due to muscle weakness, aging, or physical strain. The most common type is the inguinal hernia (groin hernia), followed by incisional hernias after previous surgeries and hernias of the anterior abdominal wall (umbilical hernia, epigastric hernia).

Typical symptoms include a feeling of pressure or pain in the affected area, a palpable bulge, and an increase in discomfort when coughing, straining, or lifting.

Hernias are often uncomfortable, but usually not immediately dangerous. However, in rare cases, bowel or fatty tissue can become trapped – a condition known as incarceration. This is a medical emergency requiring immediate presentation to a hospital emergency department. Signs of incarceration include sudden severe pain, hardening of the hernia, and redness or warmth of the overlying skin.

Hernias are primarily treated surgically, but in selected cases conservative (i.e., non-surgical) management may also be an option. This depends on factors such as the size of the hernia, symptoms, and individual health status. Whether surgery is necessary in your case and which approach is most suitable will become clear in the course of a thorough history-taking and physical examination.

Inguinal Hernia (Groin Hernia)

The inguinal hernia – also known as a groin hernia – is the most common of all abdominal wall hernias and usually presents as a visible swelling or bulge in the groin area. Inguinal hernias are more common in men than in women, but can occur at any age.

Inguinal hernias usually require surgical treatment. Depending on your individual findings and preferences, we use the following methods:

Open techniques: The hernia is repaired through an incision approximately 6 cm long in the groin. A synthetic mesh is typically used to reinforce the area (Lichtenstein procedure). In selected cases, the hernia can be closed without a mesh using a multi-row suture (Shouldice procedure). Open methods are primarily used when a minimally invasive approach is not possible or not desired, for example due to previous surgeries. We also offer open inguinal hernia surgery under local anaesthesia for patients who prefer to avoid general anaesthesia for medical or other reasons.

Minimally invasive techniques: The standard procedure for inguinal hernias is minimally invasive repair using a synthetic mesh. We use the TAPP (Transabdominal Preperitoneal Plasty) technique: access is achieved laparoscopically through the abdominal cavity, the abdomen is inflated with CO₂, and the surgery is performed through three small 5–12 mm incisions. The mesh is placed preperitoneally – between the peritoneum and the abdominal musculature. The advantages: faster recovery, less pain, and fewer wound complications. In selected cases, we also use the Da Vinci Xi surgical robot.

Hernias of the Anterior Abdominal Wall / Ventral Hernias (Umbilical & Epigastric Hernia)

Umbilical and epigastric hernias are among the most common hernias of the anterior abdominal wall. The umbilical hernia occurs around the navel – a natural weak spot in the abdominal wall. The epigastric hernia occurs along the midline between the navel and the sternum. In both cases, surgery is the treatment of choice when symptoms are present.

Open surgical methods: The incision is made directly in the area of the hernia. We close small hernias up to 1 cm using a slowly absorbable suture. Larger hernias are reinforced with a mesh in accordance with current guidelines, to minimize the risk of recurrence. We offer proven methods of mesh placement – preperitoneal (PUMP) and retromuscular (MILOS) – both characterized by particularly small skin incisions.

Minimally invasive techniques: For larger hernias, mesh reinforcement can also be performed using minimally invasive techniques. Through several incisions of approximately 10 mm, the hernial defect is closed from the inside and a mesh placed either preperitoneally or retromuscularly. These methods include laparoscopic procedures (eMILOS, eTEP) as well as robot-assisted techniques (ventral TAPP, TARUP), allowing the abdominal wall to be reinforced with very large meshes in a particularly gentle manner. Which method is right for you depends on the type and size of the hernia, your personal preferences, and your overall health – we will discuss this together at our practice in Vienna.

Incisional Hernias

Incisional hernias develop as a late complication after abdominal surgery, forming at the site of a previous surgical scar. They can become very large and, according to current guidelines, generally always require mesh reinforcement. As with ventral hernias, either an open or minimally invasive approach can be chosen. For large hernias with a hernial orifice greater than 8 cm, pretreatment of the abdominal wall – e.g., with targeted botulinum toxin injections – may be necessary. In complex cases, additional procedures such as component separation (partial release of the transverse abdominal muscles) may be required. We also use the Da Vinci Xi surgical robot where indicated. Incisional hernias are one of our core areas of expertise – particularly in complex or previously operated cases, we are your specialist team in Vienna.

Rectus Diastasis

Rectus diastasis – also known as abdominal muscle separation – describes the widening of the gap between the rectus abdominis muscles along the midline (linea alba). It frequently occurs during or after pregnancy, but can also develop with age or increasing abdominal girth.

Typical symptoms include a visible bulge in the center of the abdomen – particularly when the abdominal muscles are tensed – and in some cases back pain or a general feeling of weakness in the abdominal wall.

Treatment begins with physiotherapy to strengthen the abdominal musculature. Surgery is only considered after a trial of conservative treatment or in cases of significant physical impairment. If rectus diastasis is combined with a hernia, we recommend simultaneous mesh reinforcement of the entire anterior abdominal wall – as rectus diastasis is considered a risk factor for further hernias.

The Da Vinci Xi surgical robot represents the next generation of minimally invasive hernia surgery. Thanks to its high-definition 3D camera system and instruments with seven degrees of freedom, it enables procedures with a level of precision that cannot be achieved with conventional laparoscopic methods – allowing us to perform even complex hernia repairs minimally invasively that previously required large open incisions.

We are both certified in the Da Vinci Xi and have together completed over 320 robot-assisted procedures. We use the Da Vinci Xi at Klinik Donaustadt for both major abdominal surgeries and specialized hernia operations – including large incisional hernias, complex ventral hernias, and selected inguinal hernias. At the Wiener Privatklinik (WPK), we additionally have access to the Da Vinci X.

Not every hernia procedure requires robotic assistance. Whether we operate using a robot, laparoscopically, or open is decided together with you – individually, based on your findings, your preferences, and our experience. Our goal is always the safest and least invasive approach for you.

Whether a hernia should be operated on depends on various factors – and is always an individual decision that we make together with you. Surgery should be considered when:

• Symptoms such as pain, pressure, or other discomfort are present.
• The hernia is growing or has already reached a relevant size – in this case we recommend prompt evaluation.
• The hernia affects quality of life or limits everyday activities.
• There are aesthetic concerns – this, too, is a legitimate reason for surgery.

A medical emergency exists when bowel or fatty tissue becomes trapped in the hernia – a condition known as incarceration. Signs include sudden severe pain, hardening of the hernia, redness or warmth of the overlying skin, and in some cases nausea or vomiting. If this applies to you, please go to a hospital emergency department immediately – do not hesitate.

Ultimately, every decision about whether and how to operate is individual. What is particularly important to us: we will also advise you honestly and directly if surgery is, in our view, not the right course of action. After thorough examination at our practice in Vienna, we are happy to discuss all treatment options and find the best approach together with you.